Home Alone

72 Pages·2004·0.3 MB·English

Home Alone
Combating isolation with older
housebound people
Helen McCarthy
Gillian Thomas
First published in 2004
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Contents
Acknowledgements 7
Executive Summary 8
1. Introduction 13
2. Being Home Alone 24
3. From isolation to personalisation 37
4. Principles for personalisation 46
5. Conclusions and recommendations 57
Notes 66

Acknowledgements
Many people contributed to making this publication possible. Mark
Lever, Jim Donovan and the rest of the Senior Executive Team at
WRVS provided crucial support and input throughout the lifetime of
the project.We are grateful to all WRVS staffand volunteers who gave
up their time to participate in the research. Thanks also to Jonathan
McShane and Basil Towers at Christow.
At Demos, thanks to Sophia Parker and Matthew Horne for
helping to get the project off to a flying start,and to Tom Bentley for
providing guidance and feedback throughout.Eddie Gibb and Bobby
Webster saw the text safely through to production and publication.
Naturally,all remaining errors or omissions are our own.
Helen McCarthy and Gillian Thomas
June 2004
Demos 7
Executive summary
1. The risk of loneliness is increasing. Altered family structures,
geographical mobility and longevity are all contributing factors
to greater levels of loneliness in hidden segments of society.
Knowing how to combat loneliness is not straightforward.
Many of these risk factors are actually associated with aspects
of social progress that we cherish such as greater personal
choice and freedom. Yet, as a society, we should not tolerate
loneliness for the minority simply as the price we pay for the
social advances enjoyed by the majority.
2. Government has taken a great number of measures to protect
those most at risk of loneliness and isolation: the elderly and
housebound. The 2001 National Service Framework for Older
People outlined new principles, which aim to ensure
that services fit round the individual rather than around
professional provider roles.1 The 1999 Royal Commission on
Long Term Care recommended a whole host of measures,
including more domiciliary services, to help promote older
people’s independence.2
3. This appears to be the right strategy,yet the evidence suggests it
is not doing enough to prevent loneliness and isolation in old
age: 32 people die alone and unnoticed in their own homes
each year; one in six older people living alone rate themselves
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Executive Summary
as ‘often or always lonely’and this number is increasing.Demos
has calculated that unless significant changes occur, by 2021
nearly 2.2 million of over-65s will be socially isolated.3 So just
what is going wrong?
4. The answer lies in the failure of government to grasp that the
key to reducing loneliness lies not with the state, or even
voluntary organisations and community groups, but with
lonely people themselves. This realisation shifts the entire
framework in which older people’s services are offered. From
this new perspective, the responsibility of providers is not
simply to deliver services that meet people’s physical or
material needs,as assessed by professionals.Instead,it is about
involving and supporting service users in ‘co-producing’ their
own outcomes, so as to overcome loneliness in ways that they
define for themselves. Unleashing ‘co-production’ through
increasing the participation of older people will ultimately
move the system towards greater personalisation in all aspects
ofservice delivery.
5. The failure of policy to grasp fully this prospect explains why
the current approach to combating isolation among older
housebound people isn’t working as well as it could or should.
Services such as day and homecare focus too much on defining
needs in narrowly technocratic terms,neglecting more promising
pathways towards prevention and participation as a result.For
many older housebound people, this approach undermines
their sense of identity and self-esteem, with the only tolerable
option being to reject services and offers ofassistance entirely.
6. In fact, the services that are most likely fully to engage older
housebound people are also the services that are most likely to
suffer from budget squeeze at a local level. For example, the
Women’s Royal Voluntary Service (WRVS) runs a ‘Home from
Hospital’ service, which brings volunteers and older people
together so that they can work out the best strategies for
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Home Alone
independent living after a spell in hospital. Yet because this
service depends on local authority contracts it operates for a
very limited time span, and in a limited geographical area.
Other services such as book clubs and befriending schemes are
very successful at motivating older housebound people, but
they are often regarded as ‘nice to have’, rather than essential
from a statutory perspective.
7. Much procurement and commissioning of care and other
related services is driven by the desire for ‘best value’. Yet, in
reality, using this criterion can lead to reinforced isolation. For
example,many local authorities have moved from delivering a
hot meal to isolated housebound people once a day to
delivering them several frozen meals once a fortnight. This
potentially delivers more choice to the user and achieves
greater efficiency, but it reduces the precious social contact
associated with daily delivery.
8. The ‘business’ case for preventing or reducing social isolation
should be obvious. The medical bill alone includes treatment
arising from falls and fractures,depression and poor immunity
to disease.Ofcourse,some ofthis is caused by inevitable frailty
in older age.But too often these health complaints are the direct
result of isolated people living unsupported and demotivating
lives. ‘Delayed discharge’ costs the NHS an estimated £170
million and 1.7 million lost bed days each year. The National
Audit Office recently estimated that around 4,100 older
patients on any given day are fit enough to leave hospital, but
have nowhere appropriate to go.4
9. Furthermore, the social costs of loneliness also loom large.
Isolated people who lack opportunities to contribute to
community life represent a huge resource of untapped
potential. Friends and relatives are affected, too, and worry
about how to ask for help,or how to cope.
10 Demos